Orthopedic physicians who buy in-office imaging equipment are often tarred with the self-referral brush by radiology professionals worried about losing turf in musculoskeletal imaging. But in many cases, orthopods who install their own MRI scanners turn to radiologists - in particular teleradiology services - for assistance in reading musculoskeletal exams. Orthopedic practices are installing in-office MRI scanners for a number of reasons, including the convenience of being able to image patients in their own offices rather than sending them to another facility. Imaging vendors have developed new scanner models designed specifically for in-office siting, giving orthopedic surgeons a more economical alternative to expensive whole-body systems.
But when it comes to image interpretation, some orthopedic practices are drawing the line. Orthopedic surgeons are turning to qualified subspecialty radiologists to read these MRIs, and teleradiology practices fill this need. Orthopedic surgeons may also have a highly practical reason for seeking out a radiologist's assistance rather than interpreting complex images themselves: risk of malpractice liability.
Turning to Teleradiology
By removing the requirement that the radiologist be physically located near the referring physician's patient, teleradiology offers opportunities for increased specialization. "With the advent of high-tech MRI and multislice CT, the demand is growing for more specialized radiologists," said Scott Seidelmann, president of Franklin & Seidelmann, a Chagrin Falls, OH-based teleradiology firm. "Our view is that if you aggregate enough studies, you can specialize so well that you'll have radiologists who only read, say, shoulder studies. With that specialization comes better healthcare."
If teleradiology has become increasingly ubiquitous, there are a few key concerns regarding the trend toward its use with orthopedic practices with in-house extremity MRI units. Due to their magnetic fields, MRI scanners have particular siting requirements that may be unfamiliar to orthopedic practices, for example. Another concern is the image quality of lowresolution extremity-only MRI units.
Another question is whether orthopedists' use of extremity MRI will increase healthcare costs or decrease them, a concern some orthopedic surgeons are trying to address by developing written criteria to guide the use of MRI in each diagnostic situation.
Finally, some fear teleradiology for orthopedic practices with onsite MRI will hurt radiologists financially because the practice separates the technical and professional portions of the exam. Federal policy prevents doctors from referring patients to centers or labs in which they have financial interests, but doctors are allowed to bill for exams conducted on office equipment they own and operate, a rule some radiologists fear will affect both the quality and quantity of orthopedic MRI imaging for the worse if more orthopedic practices adopt less powerful extremity scanners.
The American College of Radiology (ACR) of Reston, VA, tried to address the issue earlier this year by proposing a new program for accrediting extremity MRI facilities. But the plan collapsed after accusations from radiology groups that felt that an accreditation program would legitimize physician self referral. The ACR instead is now lobbying Congress to monitor the installation of extremity MRI scanners in orthopedic practices, and the accreditation program remains inactive, according to Shawn Farley, public relations manager for the ACR.
Despite these issues, many radiologists are choosing to specialize in musculoskeletal imaging and to provide teleradiology services. For them, the key to success is the same as for the orthopedists: volume.
Orthopedic practices must have enough MR scan volume to make it financially feasible to engage a teleradiology firm, and teleradiology firms must have enough client volume to be viable as well, a goal that is becoming more and more challenging as demand for teleradiology services increases. But the need for experienced, technology-savvy radiologists will also increase, especially as data volume expands, according to Seidelmann.
"MRI (and CT) are getting more complex," he said. "Reading these images requires advanced education, and the demand for experienced radiologists will only continue to grow."
By Kate Madden Yee
AuntMinnie.Com Contributing Writer
September 9, 2005